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Kenmegne GR, Zou C, Lin Y, Yin Y, Huang S, Fang Y. Traumatic bilateral acetabular fracture secondary to high-energy trauma in healthy adults. BMC Surg 2024; 24:12. [PMID: 38172770 PMCID: PMC10765676 DOI: 10.1186/s12893-023-02302-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Accepted: 12/25/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Bilateral acetabular fracture is a very rare presentation among the trauma patients, as the pattern and the degree of the forces required to fracture both acetabula is very unique. The primary purpose of this study is to report a series of adult patients presenting with post-traumatic bilateral acetabular fracture without any history of pathological or metabolic bone disease. PATIENTS AND METHODS In this retrospective study, 18 cases of traumatic bilateral acetabular fracture were included. There was predominance of both column (four patients on left and six on right) followed by anterior column (two patients left and four on right) and posterior wall (three patients left and right). They were treated surgically through open reduction and internal fixation. All cases were followed up for at least 13 months. Matta's criteria were used for radiological evaluation on plain radiographs. Functional outcome was evaluated using the Merle d'Aubigne and postel score at final follow-up. RESULTS No patients were lost during the follow-up period; there was one case of surgical site infection. There were three cases of postoperative osteoarthritis, one case of heterotrophic ossification, one case of persistent sciatic nerve palsy and one case of lateral femoral cutaneous nerve palsy. The radiological evaluation according to Matta's criteria revealed anatomic reduction in 12 patients, imperfect reduction in three patients while other three patients had poor reduction. According to modified Merle d'Aubigne and Postel score, 10 cases were rated as excellent, five cases as good and three cases presented fair (one case) to poor (two cases) results. CONCLUSION We report an unusual case series of bilateral acetabular fracture successfully managed surgically with good clinical outcome. With the increasing incidence of route traffic accidents, such cases would probably be recurrent in the upcoming years.
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Affiliation(s)
- Guy Romeo Kenmegne
- Department of Orthopedics, West China Hospital of Sichuan University, Chengdu, 610041, China
- Trauma center, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Chang Zou
- Department of Orthopedics, West China Hospital of Sichuan University, Chengdu, 610041, China
- Trauma center, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Yixiang Lin
- Department of Orthopedics, West China Hospital of Sichuan University, Chengdu, 610041, China
- Trauma center, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Yijie Yin
- Department of Orthopedics, West China Hospital of Sichuan University, Chengdu, 610041, China
- Trauma center, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Shenbo Huang
- Department of Orthopedics, West China Hospital of Sichuan University, Chengdu, 610041, China
- Trauma center, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Yue Fang
- Department of Orthopedics, West China Hospital of Sichuan University, Chengdu, 610041, China.
- Trauma center, West China Hospital of Sichuan University, Chengdu, 610041, China.
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Yakkanti RR, Mohile NV, Cohen-Levy WB, Haziza S, Lavelle MJ, Bellam KG, Quinnan SM. Perioperative management of acetabular and pelvic fractures: evidence-based recommendations. Arch Orthop Trauma Surg 2023; 143:1311-1321. [PMID: 34854977 DOI: 10.1007/s00402-021-04278-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 11/24/2021] [Indexed: 12/11/2022]
Abstract
PURPOSE The American Academy of Orthopaedic Surgeons does not currently provide clinical practice guidelines for management of PAF. Accordingly, this article aims to review and consolidate the relevant historical and recent literature in important topics pertaining to perioperative management of PAF. METHODS A thorough literature review using PubMed, Cochrane and Embase databases was performed to assess preoperative, intraoperative and postoperative management of PAF fracture. Topics reviewed included: time from injury to definitive fixation, the role of inferior vena cava filters (IVCF), tranexamic acid (TXA) use, intraopoperative cell salvage, incisional negative pressure wound therapy (NPWT), intraoperative antibiotic powder use, heterotopic ossification prophylaxis, and pre- and postoperative venous thromboembolism (VTE) prophylaxis. RESULTS A total of 126 articles pertaining to the preoperative, intraoperative and postoperative management of PAF were reviewed. Articles reviewed by topic include 13 articles pertaining to time to fixation, 23 on IVCF use, 14 on VTE prophylaxis, 20 on TXA use, 10 on cell salvage, 10 on iNPWT 14 on intraoperative antibiotic powder and 20 on HO prophylaxis. An additional eight articles were reviewed to describe background information. Five articles provided information for two or more treatment modalities and were therefore included in multiple categories when tabulating the number of articles reviewed per topic. CONCLUSION The literature supports the use of radiation therapy for HO prophylaxis, early (< 5 days from injury) surgical intervention and the routine use of intraoperative TXA. The literature does not support the routine use of iNPWT or IVCF. There is inadequate information to make a recommendation regarding the use of cell salvage and wound infiltration with antibiotic powder. While the routine use of chemical VTE prophylaxis is recommended, there is insufficient evidence to recommend the optimal agent and duration of therapy.
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Affiliation(s)
- Ramakanth R Yakkanti
- Department of Orthopaedic Surgery, University of Miami University Hospital, West Wing, 1321 NW 14th st, Suite 306, Miami, FL, 33125, USA
| | - Neil V Mohile
- Department of Orthopaedic Surgery, University of Miami University Hospital, West Wing, 1321 NW 14th st, Suite 306, Miami, FL, 33125, USA
| | | | - Sagie Haziza
- Department of Orthopaedic Surgery, University of Miami University Hospital, West Wing, 1321 NW 14th st, Suite 306, Miami, FL, 33125, USA.
| | - Matthew J Lavelle
- Department of Orthopaedic Surgery, University of Miami University Hospital, West Wing, 1321 NW 14th st, Suite 306, Miami, FL, 33125, USA
| | - Krishna G Bellam
- Warren Alpert Medical School at Brown University, Providence, RI, USA
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Abstract
Heterotopic ossification (HO) refers to benign ectopic bone formation in soft tissue and is common following trauma surgery. HO bone can restrict movement and progress into ankylosis that may necessitate surgical intervention. This article discusses the current literature on the pathophysiology, prophylaxis, treatment, and epidemiology of postoperative HO following orthopedic trauma.
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Affiliation(s)
- Jad Lawand
- Department of Orthopaedic Surgery, John Peter Smith Health Network, Fort Worth, Texas, USA.
| | - Zachary Loeffelholz
- Department of Orthopaedic Surgery, John Peter Smith Health Network, Fort Worth, Texas, USA
| | - Bilal Khurshid
- Texas College of Osteopathic Medicine, Fort Worth, Texas, USA
| | - Eric Barcak
- Department of Orthopaedic Surgery, John Peter Smith Health Network, Fort Worth, Texas, USA
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Wei C, Yang M, Chu K, Huo J, Chen X, Li H. Does drainage affect development of heterotopic ossification after total hip arthroplasty? J Int Med Res 2022; 50:3000605221129562. [PMID: 36214112 PMCID: PMC9551349 DOI: 10.1177/03000605221129562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE To investigate the effect of drainage on heterotopic ossification (HO) after total hip arthroplasty (THA) and to evaluate other postoperative complications and joint dysfunction between patients with and without drainage. METHODS In this retrospective cohort study, the medical records of patients who underwent THA from 2017 to 2019 were reviewed. The patients were divided into a drainage group and non-drainage group. Standard preoperative anteroposterior and lateral radiographs were assessed by senior radiologists for HO analysis. Clinical indicators included the hemoglobin concentration, superficial infection, blood transfusion, hematoma formation, hip range of motion (ROM), erythrocyte sedimentation rate, C-reactive protein concentration, dressing changes, visual analogue scale score, and Harris Hip Score (HHS). RESULTS The incidence of HO was significantly higher in the drainage than non-drainage group (32.0% vs. 16.3%). The presence of severe HO (Brooker grade III or IV) was also different between the groups. Patients in the non-drainage group had smaller ROM early after surgery, but the final ROM and HHS did not differ significantly between the groups. CONCLUSIONS The rate and degree of HO after THA were significantly different between patients with and without drainage. There is no added advantage of closed suction drainage over no drainage in primary THA.
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Affiliation(s)
- Congcong Wei
- Department of Joint Surgery, No. 215 Hospital of Shaanxi Nuclear
Industry, Xianyang, Shaanxi, P.R. China
| | - Meng Yang
- Department of Osteonecrosis and Hip Surgery, the Third Hospital
of Hebei Medical University, Shijiazhuang, Hebei, P.R. China
| | - Kun Chu
- Department of Osteonecrosis and Hip Surgery, the Third Hospital
of Hebei Medical University, Shijiazhuang, Hebei, P.R. China
| | - Jia Huo
- Department of Osteonecrosis and Hip Surgery, the Third Hospital
of Hebei Medical University, Shijiazhuang, Hebei, P.R. China
| | - Xiao Chen
- Department of Osteonecrosis and Hip Surgery, the Third Hospital
of Hebei Medical University, Shijiazhuang, Hebei, P.R. China
| | - Huijie Li
- Department of Osteonecrosis and Hip Surgery, the Third Hospital
of Hebei Medical University, Shijiazhuang, Hebei, P.R. China,Huijie Li, Department of Osteonecrosis and
Hip Surgery, the Third Hospital of Hebei Medical University, No. 139 Ziqiang
Road, Shijiazhuang, Hebei Province 050051, P.R. China.
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Yeung P, Zarnett O, Lefaivre KA, Guy P. Risk Factors for the Development of Heterotopic Ossification Following Acetabular Fractures: A Systematic Review. JBJS Rev 2022; 10:01874474-202209000-00005. [PMID: 36137013 DOI: 10.2106/jbjs.rvw.20.00263] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Heterotopic ossification (HO) following acetabular fractures is a common complication that may affect clinical outcomes. However, the effects of prophylactic treatment with nonsteroidal anti-inflammatory drugs or radiation therapy remain controversial. While several factors have been related to the development of HO, there is considerable uncertainty regarding their importance or effect size in the setting of acetabular surgery. Therefore, this systematic review aims to summarize the risk factors for HO following the operative fixation of acetabular fractures and clarify their interrelationships. METHODS In accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, PubMed, MEDLINE, Embase, and CINAHL databases were searched from inception to February 2021. Studies that assessed factors related to HO development among patients with operatively repaired acetabular fractures were included. Outcomes were risk factors and their effect size (p values, odds ratios, and 95% confidence intervals). RESULTS Twenty-five studies and 1 conference abstract with a total of 3,940 patients were included. The following risk factors for HO were identified. Patient factors were increased body mass index, male sex, and increased age. Injury factors were intensive care unit (ICU) admission and length of stay, non-ICU hospitalization for >10 days, the need for mechanical ventilation for ≥2 days, abdominal and/or chest injuries, the number and type of associated fractures, traumatic brain injuries, T-type acetabular fractures, pelvic ring injuries, and hip dislocation. Care factors were a delay to surgery, extensile and posterior surgical approaches to the hip, trochanteric osteotomy, postoperative step-off of >3 mm, and a delay to prophylaxis following injury or surgery. Ethnicity, Injury Severity Score, cause of the fracture, femoral head injuries, degloving injuries, comminution, intra-articular debris, the type of bone void filler, gluteus minimus muscle preservation, prolonged operative time, and intraoperative patient position were not risk factors for developing HO. CONCLUSIONS HO following operative fixation of acetabular fractures is not uncommon, with severe-grade HO associated with substantial disability. Careful consideration of the risk factor effect sizes and interdependencies could aid physicians in identifying patients at risk for developing HO and guide their prophylactic management. The results of this study could establish a framework for future studies. LEVEL OF EVIDENCE Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Phillip Yeung
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Oren Zarnett
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kelly A Lefaivre
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Pierre Guy
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Hip Health and Mobility, University of British Columbia, Vancouver, British Columbia, Canada
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6
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Gluteus Minimus Debridement During Acetabular Fracture Surgery Does Not Prevent Heterotopic Ossification-A Comparative Study. J Orthop Trauma 2021; 35:523-528. [PMID: 33480642 DOI: 10.1097/bot.0000000000002061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/14/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To compare rates of heterotopic ossification (HO) after acetabular fracture surgery, through a posterior approach, with and without gluteus minimus muscle (GMM) debridement. DESIGN Retrospective comparative study. SETTING Single academic Level I trauma center. PATIENTS Ninety-four patients in the GMM preserved group and 42 patients in the GMM debrided group met inclusion criteria. INTERVENTION GMM preservation or debridement during acetabular fracture surgery through a single-posterior approach. MAIN OUTCOME MEASUREMENTS Primary outcomes were incidence and severity of HO. Reoperation for HO excision was assessed. Other risk factors for severe HO (Brooker class III-IV) were secondarily assessed using multivariable logistic regression analyses. Odds ratios (ORs) with 95% confidence intervals were calculated. The significance was set at P-value ≤ 0.05. RESULTS There was no difference in the incidence or severity of HO between the debrided and preserved groups. Rates of reoperation for HO excision were comparable. American Society of Anesthesiologists physical status class (OR = 3.3), head injury (OR = 4.6), and abdominal injury (OR = 4.5) were associated with severe HO. CONCLUSION GMM debridement was not associated with a decreased incidence of HO after acetabular fracture surgery. American Society of Anesthesiologists class is a novel risk factor associated with severe HO formation. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Li Z, Li J, Li Z, Nie S, Zhang H, Li M, Liu J, Liu Z, Xu G, Zhang L, Tang P. Comparative study of anatomical locking plate and reconstruction plate in treating acetabular fractures. INTERNATIONAL ORTHOPAEDICS 2021; 45:2727-2734. [PMID: 33585973 DOI: 10.1007/s00264-021-04970-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Accepted: 02/02/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE This study aims to compare the effectiveness of anatomic locking plate and reconstruction plate used in treating acetabular fractures. METHODS From January 2009 to January 2016, patients with acetabular fractures were included in this retrospective study. We grouped the patients into two groups based on the internal fixation: reconstruction plate group (RPG) and anatomic locking plate group (ALPG). The operation time, blood loss, intra-operative screw penetration, and plate breakage were compared between the two groups. The intra-operative fluoroscopic images were used to evaluate the fixation location. The quality of reduction and radiological grading were assessed according to the criteria developed by Matta. The clinical assessment was based on the Merle d'Aubigne-Postel score. RESULTS Eighty-three patients were included in this study and were followed up for an average of 35 months (range, 25 to 42 months). Thirty-five patients were treated with the anatomical locking plate, and 48 patients were treated with the reconstruction plate. The mean surgical time was significantly shorter (P < 0.0001) in ALPG patients than in RPG patients, and the intra-operative blood loss was significantly lower (P = 0.008). The rates of intra-operative screw penetration or plate breakage in the ALPG (0/35) are significantly lower than that in the RPG (7/48) (P = 0.018). Post-operative Matta score (P = 0.905), Merle d'Aubigne-Postel score (P = 0.957), and overall complication rates (P = 0.391) were not significantly different among the groups. CONCLUSION Patients treated by anatomical locking plate had shorter operation time, less bleeding, and lower rate screw perforation compared to patients treated by reconstruction plate. Anatomical locking plate is a better choice for acetabulum fractures, especially complicated fractures.
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Affiliation(s)
- Zhijiang Li
- Department of Orthopaedics, Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing, 100853, China.,National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, No. 28 Fuxing Road, Beijing, 100853, China
| | - Jiantao Li
- Department of Orthopaedics, Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing, 100853, China.,National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, No. 28 Fuxing Road, Beijing, 100853, China
| | - Zhirui Li
- Department of Orthopaedics, Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing, 100853, China.,National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, No. 28 Fuxing Road, Beijing, 100853, China
| | - Shaobo Nie
- Department of Orthopaedics, Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing, 100853, China.,National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, No. 28 Fuxing Road, Beijing, 100853, China
| | - Hao Zhang
- Department of Orthopaedics, Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing, 100853, China.,National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, No. 28 Fuxing Road, Beijing, 100853, China
| | - Ming Li
- Department of Orthopaedics, Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing, 100853, China.,National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, No. 28 Fuxing Road, Beijing, 100853, China
| | - Jianheng Liu
- Department of Orthopaedics, Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing, 100853, China.,National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, No. 28 Fuxing Road, Beijing, 100853, China
| | - Zhongyang Liu
- Department of Orthopaedics, Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing, 100853, China.,National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, No. 28 Fuxing Road, Beijing, 100853, China
| | - Gaoxiang Xu
- Department of Orthopaedics, Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing, 100853, China.,National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, No. 28 Fuxing Road, Beijing, 100853, China
| | - Licheng Zhang
- Department of Orthopaedics, Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing, 100853, China. .,National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, No. 28 Fuxing Road, Beijing, 100853, China.
| | - Peifu Tang
- Department of Orthopaedics, Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing, 100853, China. .,National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, No. 28 Fuxing Road, Beijing, 100853, China.
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8
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Freije SL, Kushdilian MV, Burney HN, Zang Y, Saito NG. A Retrospective Analysis of 287 Patients Undergoing Prophylactic Radiation Therapy for the Prevention of Heterotopic Ossification. Adv Radiat Oncol 2020; 6:100625. [PMID: 34195485 PMCID: PMC8233464 DOI: 10.1016/j.adro.2020.11.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 10/30/2020] [Accepted: 11/11/2020] [Indexed: 11/26/2022] Open
Abstract
Purpose Heterotopic ossification (HO) is a potentially disabling disorder of ectopic bone formation secondary to orthopedic surgery or trauma. In this retrospective analysis we evaluated the outcomes of patients who received radiation therapy (RT) for HO prophylaxis. Methods and Materials A total of 287 patients who received RT for HO prophylaxis at a major trauma center from 2007 to 2018 were analyzed. Data collected included types of injury, surgery, time intervals between key events, development of postprophylaxis HO, and secondary malignancies. Associations between various factors and the risk of developing HO were analyzed. Kaplan-Meier analysis was used to estimate failure rates. Results The most common indication for RT was traumatic acetabular fracture (83.3%). Twelve patients (4.2%) developed postprophylaxis HO with a median time to failure of 8.6 months (2.8-24.5). Kaplan-Meier 1-, 2-, and 5-year failure rates were 3.7%, 4.4%, and 7.4%, respectively. Injury type and timing of RT were not associated with the risk of failure, but we observed a trend of increased risk of failure in patients with longer time between surgery and RT (odd ration [OR] 1.68, P = .056). Current or former smokers (51.7%) were less likely to fail (OR 0.10, P = .03). There was no incidence of in-field secondary malignancy. Conclusions There was no significant association between injury and fracture type, surgical approach, or timing of RT and development of HO, contrary to published reports of increased HO risk with certain surgical approaches and longer time intervals between injury and surgery, suggesting that prophylactic RT might play a role in mitigating these effects. Decreased risk of postprophylaxis HO among former or current smokers was unexpected. No secondary malignancy in the RT field was identified, although the median follow-up was only 17 months. Compared with published HO incidences (17%-39%) in patients who receive no prophylaxis after traumatic acetabular fractures, our results are highly suggestive of the efficacy of prophylactic RT.
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Affiliation(s)
- Samantha L Freije
- Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Michael V Kushdilian
- Department of Radiology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Heather N Burney
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana
| | - Yong Zang
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana
| | - Naoyuki G Saito
- Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, Indiana
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Tosounidis TH, Giannoudis VP, Kanakaris NK, Giannoudis PV. The Kocher-Langenbeck Approach: State of the Art. JBJS Essent Surg Tech 2018; 8:e18. [PMID: 30233990 DOI: 10.2106/jbjs.st.16.00102] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Introduction The Kocher-Langenbeck approach is the workhorse for the reduction and fixation of hip fractures that require fixation via a posterior approach1,2. Indications & Contraindications Step 1 Preoperative Planning Review the patient's general condition and imaging studies, plan the sequence of reduction and fixation, and make sure that all of the necessary equipment is available. Step 2 Preparation and Patient Positioning Induce anesthesia, administer intravenous antibiotics as per local hospital protocol, apply antiembolism stockings, and insert a Foley catheter to the bladder. Step 3 Kocher-Langenbeck Approach Make an incision that is 15 to 20 cm long and has 2 parts (proximal and distal), which are centered over the greater trochanter. Step 4 Fracture Reduction and Fixation The reconstruction of posteriorly based fractures depends on the specific fracture type, and the goal is to provide stable column fixation and anatomical reconstruction of the acetabular articular surface, with column fixation performed before the reconstruction of the posterior wall. Step 5 Wound Closure and Postoperative Care Meticulous hemostasis, application of drains, and watertight closure are the final steps of the operation. Results The Kocher-Langenbeck approach is the workhorse for the surgical management of acetabular fractures and provides sufficient access to the majority of posterior based acetabular fractures15. Pitfalls & Challenges
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Affiliation(s)
- Theodoros H Tosounidis
- Academic Department of Trauma & Orthopaedic Surgery, University of Leeds, Leeds General Infirmary, Leeds, United Kingdom.,NIHR Leeds Biomedical Research Unit, Chapel Allerton Hospital, Leeds, United Kingdom
| | | | - Nikolaos K Kanakaris
- Academic Department of Trauma & Orthopaedic Surgery, University of Leeds, Leeds General Infirmary, Leeds, United Kingdom
| | - Peter V Giannoudis
- Academic Department of Trauma & Orthopaedic Surgery, University of Leeds, Leeds General Infirmary, Leeds, United Kingdom.,NIHR Leeds Biomedical Research Unit, Chapel Allerton Hospital, Leeds, United Kingdom
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10
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Bajwa NM, Kesavan C, Mohan S. Long-term Consequences of Traumatic Brain Injury in Bone Metabolism. Front Neurol 2018; 9:115. [PMID: 29556212 PMCID: PMC5845384 DOI: 10.3389/fneur.2018.00115] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Accepted: 02/15/2018] [Indexed: 12/14/2022] Open
Abstract
Traumatic brain injury (TBI) leads to long-term cognitive, behavioral, affective deficits, and increase neurodegenerative diseases. It is only in recent years that there is growing awareness that TBI even in its milder form poses long-term health consequences to not only the brain but to other organ systems. Also, the concept that hormonal signals and neural circuits that originate in the hypothalamus play key roles in regulating skeletal system is gaining recognition based on recent mouse genetic studies. Accordingly, many TBI patients have also presented with hormonal dysfunction, increased skeletal fragility, and increased risk of skeletal diseases. Research from animal models suggests that TBI may exacerbate the activation and inactivation of molecular pathways leading to changes in both osteogenesis and bone destruction. TBI has also been found to induce the formation of heterotopic ossification and increased callus formation at sites of muscle or fracture injury through increased vascularization and activation of systemic factors. Recent studies also suggest that the disruption of endocrine factors and neuropeptides caused by TBI may induce adverse skeletal effects. This review will discuss the long-term consequences of TBI on the skeletal system and TBI-induced signaling pathways that contribute to the formation of ectopic bone, altered fracture healing, and reduced bone mass.
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Affiliation(s)
- Nikita M Bajwa
- Musculoskeletal Disease Center, VA Loma Linda Healthcare System, Loma Linda, CA, United States
| | - Chandrasekhar Kesavan
- Musculoskeletal Disease Center, VA Loma Linda Healthcare System, Loma Linda, CA, United States.,Department of Medicine, Loma Linda University, Loma Linda, CA, United States
| | - Subburaman Mohan
- Musculoskeletal Disease Center, VA Loma Linda Healthcare System, Loma Linda, CA, United States.,Department of Medicine, Loma Linda University, Loma Linda, CA, United States.,Department of Orthopedic Surgery, Loma Linda University, Loma Linda, CA, United States
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11
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Elhassan Y, Abdelhaq A, Piggott RP, Osman M, McElwain JP, Leonard M. Heterotopic Ossification following acetabular fixation: Incidence and risk factors: 10-year experience of a tertiary centre. Injury 2016; 47:1332-6. [PMID: 26997132 DOI: 10.1016/j.injury.2016.03.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2015] [Revised: 02/15/2016] [Accepted: 03/04/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND Heterotopic Ossification (HO) is a well-recognized complication following acetabular fracture fixation and its presence is prognostic for suboptimal clinical outcome. There are many controversies pertaining to its aetiology, including surgical approach, associated injuries and the use of HO prophylaxis. Long term data from high volume centres is necessary to address these issues. AIM To determine the incidence of HO post open reduction and internal fixation (ORIF) of acetabular fractures and to examine the associated risk and prognostic factors. METHOD We studied a cohort of 369 consecutive acetabular fractures that underwent ORIF at our institution over a 10 year period. Data was analyzed using univariate and multivariate logistic regression. RESULTS The existence of HO was evident in 65 patients (17.62%), of these 39 (60.0%) were Class I, 16 (24.6%) were Class II, 8 (12.3%) were Class III, and 2 (3.1%) were Class IV according to Brooker Classification. We found a significant association between admission to an Intensive Care Unit (ICU) (P-value=0.039), chest injury (P-value=0.013), multiple fractures (P-value=0.005), and the time lapse between injury and operation (P-value=0.025), and some statistical significance with surgical approach, ipsilateral fractures, open fractures, tibial and patellar fractures. Age over 30 years as the only prognostic factor for severe HO. Prophylaxis with Indomethacin did not appear to confer any benefit in our patient group. CONCLUSION The risk factors for developing HO following acetabular fracture fixation are multifactorial and include admission to ICU, associated chest injuries, multiple fractures and delay between injury and surgery. Surgical approach, ipsilateral fractures and tibia and patellar fractures may also play a role. Age over thirty years was the only prognostic factor for developing severe HO.
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Affiliation(s)
- Yahya Elhassan
- National Centre for Pelvic & Acetabular Surgery, The Adelaide and Meath Hospital, Dublin, Incorporating the National Children's Hospital, Dublin 24, Ireland.
| | - Ady Abdelhaq
- National Centre for Pelvic & Acetabular Surgery, The Adelaide and Meath Hospital, Dublin, Incorporating the National Children's Hospital, Dublin 24, Ireland.
| | - Robert P Piggott
- National Centre for Pelvic & Acetabular Surgery, The Adelaide and Meath Hospital, Dublin, Incorporating the National Children's Hospital, Dublin 24, Ireland.
| | - Mugtaba Osman
- Department of Psychiatry, University College Dublin, Ireland.
| | - John P McElwain
- National Centre for Pelvic & Acetabular Surgery, The Adelaide and Meath Hospital, Dublin, Incorporating the National Children's Hospital, Dublin 24, Ireland.
| | - Mike Leonard
- National Centre for Pelvic & Acetabular Surgery, The Adelaide and Meath Hospital, Dublin, Incorporating the National Children's Hospital, Dublin 24, Ireland.
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